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Health IT Use, Workarounds Among Top 10 Patient Safety Concerns

Problems with health IT use safety, workarounds, and care coordination ranked among ECRI’s top patient safety concerns in 2018.

Source: Thinkstock

By Kate Monica

- EHR system workarounds, lack of health IT use safety, and problems with internal care coordination were named among the top 10 patient safety concerns for healthcare organizations in 2018, according to a report from ECRI Institute.

ECRI Institute created this year’s iteration of the annual list by analyzing data regarding patient safety events and concerns contained within its patient safety organization (PSO) database.  The database includes more than 2 million patient safety events spanning nine years.

In addition to patient safety events within the PSO database, the institute also analyzed PSO members’ root-cause analyses and research requests, topics reflected in weekly HRC Alerts, and votes submitted by a panel of internal and external experts to develop the list.

According to ECRI Institute, the top two patient safety concerns of 2018 were diagnostic errors and problems with opioid safety across the care continuum.

Problems with internal care coordination ranked as the third most significant safety concern of the year.

“Poorly coordinated care puts patients at risk for safety events such as medication errors, lack of necessary follow-up care, and diagnostic delays,” wrote ECRI researchers. “Like so many preventable errors in healthcare, these risks come down to a failure to communicate.”

Healthcare organizations can help to improve communication between providers within the same health system by encouraging care teams to use admission, discharge, and transfer (ADT) notifications and alerts. ADT notifications can be imbedded into EHR systems to inform providers across care settings or facilities of a patient’s location and status to improve care coordination.

Additionally, clinicians can share patient medical histories, medication lists, and other kinds of information through health data exchange to ensure providers within the health system are aware of all relevant clinical information. In a recent AJMC study, Diagnostic health data sharing within health systems was correlated with improved health outcomes for patients with heart failure.

“Many handoff tools are available to ensure the vital information is communicated and the process is standardized,” said ECRI Institute Senior Patient Safety Analyst Elizabeth Drozd.

The fourth-most significant patient safety concern of 2018 involved workarounds.

“Workarounds are pervasive in healthcare,” wrote researchers. “They occur when staff bend work rules to circumvent or temporarily fix a real or perceived barrier or system flaw.”

EHR workarounds are especially common and can negatively impact both patient safety and clinical productivity.

Medical Center Health System (MCHS) in Texas recently cited EHR workarounds as one of the primary causes of complications during a Cerner implementation that led to rising tensions between management and medical staff.

To avoid conflict between management and staff, ECRI Institute authors suggested organizations foster a hospital culture where staff members feel comfortable discussing concerns with procedures and technology.

“Organizations should encourage staff to speak up about workarounds by fostering an open, non-punitive environment where staff feel at ease talking about them,” researchers stated. “A gap analysis of processes susceptible to workarounds can help identify mismatches between scripted and actual practices.”

Additionally, researchers advised that healthcare organizations take staff input into account when developing policies and procedures.

“Finally, given that workarounds often occur with technology, ensure that an ongoing maintenance plan is in place for the technology to perform reliably,” authors wrote.

Lack of health IT safety ranked as the year’s fifth highest patient safety concern. Report authors emphasized the importance of developing a health IT safety program that encourages medical staff to recognize, react to, and report on health IT-related patient safety events.

“If staff fail to recognize health IT issues when they emerge, then they may not know how to intervene,” cautioned authors.

Healthcare facilities using poorly-designed health IT systems or operating without health IT safety programs may be at a higher risk of posing threats to patient safety.

“It is not only how we use it in daily workflow, but also how we use it effectively by optimizing the benefits and reducing the risks,” said ECRI Institute Patient Safety Analyst and Consultant Robert Giannini.

Other top patient safety concerns of 2018 included poor management of behavioral health needs in acute care settings, lack of all-hazards emergency preparedness, lack of device cleaning and sterilization, lack of patient engagement, and problems with leadership engagement.

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